what with leg waxing, migraines have to do, or how to consolidate pain

So, a few weeks ago, Nayla asked me what I will do about my migraines if ever I am pregnant. Well, although I doubt I'm pregnant, there is going to be, at least until the big drugs and needles and pricy doctors are involved, that week before the most expensive five inch plastic stick to ever grace a drugstore shelf can tell me whether or not it's ok to take a Relpax. And because apparently I STILL haven't learned not to tempt fickle fate, I didn't plan ahead and therefore found myself with a minor migraine on Sunday night that by Tuesday night was a six flag ringer, complete with flashing lights and hours of vomiting and even a near constant right eye watering trick that has never happened before, but emerged with this migraine like one big unwelcome party trick. And I did not take my Relpax, surely the worst of the worst teratogonic drugs, right up there with thalidomide and DDT. (Just kidding. Actually Relpax is a pregnancy Class C drug, which means that nobody knows the effect on a developing fetus). But as anyone who has ever gone to Catholic School, much less sat through an embryology class knows, spinal cord and limb development happen in the precarious first few weeks, usually before the majority of the non fertility obsessed population becomes aware that they are pregnant.

Wednesday morning I broke down and called my neurologist. I was immediately transferred to "Jennifer," a nurse who is truly an angel. If I was the boss of the world, I would make every medical professional take lessons from her. I explained my situation and she offered to give me a blood HCG draw STAT. If that came back negative, I could take my Relpax with impunity. If it didn't, they would give me the regimen they usually prescribe to pregnant woman, which is Tylenol-3, Tylenol with codeine. Between two and four tablets, adjusted for height and weight. Safe during pregnancy? Perfectly, apparently. Actually I was going to wait out the results of the HCG test and then stick with the Relpax, but then I found out that the lab draw center, which sends samples out for analysis, considers STAT to be 4-5 hours. So I picked up the T3 prescription and drove to my office, where I sat through not one, not two, but four meetings. But that was perfectly fine. Because I work in a state building, the bar for general cognition is not set high.

And the verdict? A most effective pain killer. Next time, I'm going to multi task those pain killing properties and schedule a leg wax for the same day. If I can just get past my fear of phthalates in the wax.

Way #457 in which trying to get pregnant is going to be the death of me

I am typing this while periodically checking the tip of my left index finger, which won’t stop bleeding in the way that skin sliced by glass often does not. All because this morning I tried to take my temperature, a project that involves keeping in one’s mouth- not a digital thermometer, the type sensible people use because otherwise it really sucks to bite down on one of the glass ones, an unfortunately likely scenario if you:

a. are preoccupied, because the key to an accurate basal body temperature reading is taking your temperature before doing anything- getting up, talking, cognition, and so

b. might be therefore prone to forget that you also have small protruding orthodontic attachments, which then cause you to bite down and shatter the stupid thing in your mouth.

As far as a way to start the morning goes, I can’t recommend it. I was taking my temperature in the first place because this is my first month off birth control, which means that I am morally obligated not to consume my usual pharmacological pharmacopoeia in the second half of my cycle. A precaution no doubt pointless, but I don’t tempt fate. There’s this great line in the memoir by Christopher Buckley, referring to his sick father’s medication schedule, and says something to the effect of “enough to give Hunter S. Thompson pause.”

Although certainly not the type to elicit his post mortem envy, consisting as my intake does of:

-Claritin (the real stuff, with pseudoephadrine and not that silly phenylephrine (sp). Here “sp” refers to spelling, and not some sort of fancy time-release capsule. I need somebody to please explain to me how it would be cost effective for the methamphetamine makers to buy Claritin at nearly $16 a box, distill the pseudoephadrine down, and then sell the final product as street crack for what, five bucks? It doesn’t make sense. Even if methamphetamine dealers aren’t the savviest group. Honestly, fellow allergy sufferers, I could take this straight to Capital Hill.

-Wellbutrin SR, which I weaned myself off a month ago but is nevertheless a dearly missed friend, and last but not least

-Relpax. Relpax is the only thing, short of a medically induced coma and general anesthesia, that touches my migraines.

And therein lies the necessity of knowing exactly where things stand, ovulation wise.

My husband considers the ability to tolerate otherwise easily medicated medical conditions to be a barometer for personal character. I disagree. I don’t abuse drugs and because I have severe control issues that require me to be aware of everything all the time, I never have. But I have no problem taking them when indicated, which leads to weird juxtapositions like being perfectly happy to gulp down an entire endoscope, yet taking a Xanex or three for certain pelvic procedures. Which, in my mind, is perfectly acceptable. Certainly I suffer from vestigial psychic heebe geebes regarding these procedures, and that’s for me to work out with my therapist if I so chose, not to be gotten through with a brand new OB/GYN resident and the dreaded tomcat catheter.

But at the moment, I was more concerned about my mouthful of broken glass. Luckily, I knew exactly what I needed to evaluate the pieces of glass, but unluckily, we don’t have any of those black velvet covered jeweler’s flats lying around the house.

Several things happened at once. I opened the door, and the cat (who waits at the door, no doubt certain of the eventual inevitability of a day like today) darted into the bedroom, a place where her presence is strictly forbidden. The dog barked wildly in his crate, my husband slammed the door to his study, and I stubbed my toe on corner of the bathroom sink, causing me to speak one or two words that I normally do not.

In the end, after a careful forensic reconstruction of the thermometer (Germar, Mercury Free, printed on the back, the mercury free substance being in any case encapsulated in a separate container within the thermometer), it appeared that what was missing amounted to glass dust, probably lost in the bed or in the exclamations that followed after I stubbed my toe. I did confirm that the broken shards were glass and not, in fact, safety plastic, if there is such a thing. I figured this out by jabbing my index finger with one, an act that was, I have to admit, not too clever.

But in any case, I don’t really know of anyone who has actually died from eating glass. Come to think of it, the only instance of death by glass eating I am familiar with occurred in a V.C. Andrews book. Nayla, please take note. If I do die and you decide to capitalize on that with a ghost ridden Coordination and Fertility Impaired Flowers in the Audi, please take note: I am a fourth generation Daughter of the American Revolution and lots of bad karmic legacy stuff already happened to my family. Please, please don’t lock us in any attics.

more on this later

Star Trek and the Two Week Wait

As some of you already know, I am a big fan of Star Trek. It was through an episode of the original Star Trek series entitled Mirror, Mirror that I first learned of the concept of an alternate reality. In the alternate reality of that episode, Spock had a goatee, and Lt. Uhura was dressed in a very slutty ensemble, and torture and assassination were legitimate means of career advancement.

You may be wondering what this has to do with my current situation.

Well, today I had the blood draw that determines whether I am pregnant. I will not be posting the results of this test on this blog for a while. So, for you dear reader, there will exist two realities, the one where I am not pregnant and am very sad, and the one where I am pregnant, and am not sad, but worried about miscarrying, as happened last time.

A few days ago, my mother asked me whether I felt the same as the last time I was waiting to find out whether I was pregnant, and I had to remind her that the last time I was waiting to find out whether I was pregnant, my father got his terminal diagnosis. Maybe that is why I feel a little sad, a little angry, and a little tired, all at once. It has been a difficult nine months since that time.

So for now, I offer you the two realities. And if it amuses you to picture me pregnant, and in a slutty Star Trek uniform, so be it.

The Christmas Spirit Will Not Be Taking Calls This Afternoon

The Christmas Spirit Will Not Be Taking Calls This Afternoon

After a day of firing off emails to my sister (first empathetic and gentle, later accusatory and cheapshotish, a word that I really would like to see translated into German or some other sturdy case language), I received confirmation that the rumor I heard from my mother was true- “K” is not coming home for Christmas. I wasn’t surprised but I wasn’t happy, either. Christmas, in our family, has not been a particularly life affirming holiday for the past several years, and last year was downright miserable. But this year my mother has already volunteered to work at the hospital on Christmas day, and my husband and I just spent Thanksgiving in a restaurant, and I don’t care how nice the restaurant or how well executed the menu, there are only a few good reasons to eat out on Thanksgiving and Christmas. Personally, I think that trusting oneself around people not immediate family is one of them, but I do now get why at the Grateful Dead shows there was always an area cordoned off for the “sober” people. Sometimes it helps to be with people in the same situation. In my situation, that would mean a table full of seemingly normal individuals who at any given moment break out into tears and scratch their faces. Clearly it is too early in the morning for me to be writing this.

But my sister has a medium good reason for not flying from Chicago to California, and then back again, and that reason is that she is leaving on December 27th to go to Mexico City. For…vacation? I’ve been told that it’s tacky and disrespectful to joke about the illegal organ traffic of other cities and so I’m not going to do that anymore. This trip follows on the heels of her recent fall “bicycle tour” of Detroit and nascent interest in outsider art, and I have to wonder what might be next. Birdwatching in the DRC? I attribute some of this to the fact that our father was a bit overprotective, when it came to physical security, but I keep telling her that there has to be a happy medium, and because I am seven years older and she doesn’t have to listen to me, well, she doesn’t.

In other news, the annual state employee office nativity scene reenactment is under way.

way #456 in which It Could Always Be Worse

So my psychiatrist thinks that no matter what happens in the next few months (in an effort to be more superstitious, I’m intentionally leaving the possibilities vague), I must not delay IVF again.

And (you might think this would lead her to take less of a hard line approach to the situation, but you’d be wrong) she thinks it’s weirder than I do, the whole fertility mortality situation (or rather, assisted fertility treatments concurrent with imminent mortality). I guess that’s a more direct way to put it. I think it’s not so weird at all. If the sandwich generation is taxed by the bizarre situation of taking care of their children and their elderly parents, it stands to fallow (follow! follow!) that there should be a subset of that generation who are still trying to have those children. I think that most of the friends I made as an adult have married and had their children in their thirties- and many of them haven’t even started trying yet. So this sort of thing is probably going to be a whole lot more common. And maybe it’s because I’ve been so wrapped up in the weirdness of it (by that I mean thinking about it objectively, constructively, a development for which I am grateful beyond words,) for, oh, say, the past month or so (thank you Nayla), that I haven’t noticed how in this month a whole other subset of friends seem to be having the proverbial mid life crisis, a process which hasn’t seemed to exclude any of the traditional behavioral caricatures (new car, new spouse, in one particular case, a weird obsession with roller derby and a –unrelated, I’m sure- switch in sexual orientation). So, I’m not going to say too much more about this, because the situations are obviously agonizing and not funny at all to the people going through them, but it did occur to me that those of us who put the Clomid in a separate cupboard from the one where we kept the Xeloda and post chemotherapy Compazine, are probably not going to buy outrageous new cars or have a marital crisis predicated on some guy who mucks out horse stalls and isn’t even old enough to drink, for goodness sakes. I’m trying to figure out if mail order fertility medication is cheaper (but how exactly are those FedEx trucks temperature controlled…because I know what happened once to a batch of measles vaccine in Sierra Leonne and it was not good), while my best New York friend is bemoaning his alimony payments and booking a trip to Fiji with a pole dancer (hi Jay).

The Great Needle Reprieve of 2009

Just as Courage the Turkey has been offered pardon by President Obama, so I have been offered reprieve from the terrible progesterone-in-oil shot.

Ever since my first progesterone shot, I have developed a fever of between 101 and 102 every day from 5 pm to 11:30. The kind of fever that makes me want to layer on four sweaters, fleece pants, a coat, gloves and a hat. I alerted my medical professionals to this on day one, and they responded that the fever had nothing to do with anything they were doing. This went on and on for four days, and then Tuesday, my husband came home and found me under the traditional pile of outwear and blankets and declared that this was not normal and that possibly I had the swine flu. He called the doctor and persuaded him to "have me evaluated the next day."

The next day, I went in, and the nurse evaluated me, came to the conclusion that I did not have the swine flu, and said that she had never seen anyone have a fevers like this in reaction to progesterone-in-oil injections. But they agreed to let me switch to a different form of progesterone supplementation after just one more shot. To stop my constant complaining, I suppose. So now, even though I had that last shot yesterday, and spent my evening shivering on the couch, a delight to all in the family, and even though I still have welts on each of my butt cheeks, I am free of needles for the time being. Hooray!! I am also apparently free of fevers, as it is now 6:17, and I am tired and nauseated, but not shivering.

I am thankful for alternatives to progesterone-in-oil shot.

Happy Thanksgiving!

refined carbohydrates, leisure time, and the mentally ill

In our town there is a small Italian pastry shop and cafe, where as a condition of admittance you must relinquish at least three hours of your life. Generally, this amounts to spending the next one hundred and eighty minutes with a foamy cappuccino and one of their outrageously delicate caramel glazed palm leaf shaped cookies. My husband loves this place, it is his own Pyrenees in Marin County. I have anxiety issues and must be productive at all times, so it doesn't work out so well for me. But I do have a counterpart just a block away, my own little enclave of the upper West Side, and this is in the cozy office of my psychiatrist. BlueCross PPO, I love you. Dr J is whip-smart, beautiful, doesn't suffer fools, and I envy her for her wardrobe. She owns the cutest jumpers I've ever seen. And she says all the right things, like the time when my in laws were planning an extended visit ("if my mother in law was coming for three weeks, I'd take a shotgun and blow my brains out") or the time when I complained that my husband's friends do tend to drink, and drunk grown ups make me uncomfortable ("sweetheart, if I had to sit through one of your vegan raw foodist events, I'd light up a joint too.") Usually, I walk into her office pretty much convinced that I am a crazy person, and by the time I leave, that craziness has been downgraded to an only slightly abnormal response to a bizarre world. So today, in spite of the fact that my mother is going on her fourth week of weird non specific back pain, I left her office today with relatively little teeth gnashing and hair tearing. And then waved at my husband, still in front of the pastry shop.

straight from the mouth of...Christopher Buckley?

While Nayla is on her two week couch rest, I have resolved to only say and write happy pleasant things, sunshine and roses (dasies, dare I say)? But at risk of bringing up illness and mortality and also outragously good natured humor, I need to post a link to a book I wish I'd had in hand this time last year.

Ok, two links. Two too good reviews.

New Public Service Ad

The full bladder trick, in foot tall letters, on the sides of municipal transport buses.

Ah, the progesterone shot. I’ve seen pictures of the progesterone shot. Specifically, I’ve seen mobile phone pictures of a particular surface area of flesh, very bruised, very traumatized. I now understand this to be the “hip,” post progesterone shot. I didn’t ask to see them, but a very likely, very well meaning person took it upon himself to share this memory from his own IVF files. Certainly, needle counts are one thing. Photomontages, outtakes on the Blackberry, in the middle of an office, for goodness sakes, are something else entirely.

Which isn’t to say that I don’t understand how it happened. I get that you can go through your whole life without any GGW digital media skeletons in proverbial closets. In fact, two months ago, I found myself taking a few self-portraits to show my neurologist that a specific vein in my face does protrude during a certain kind of migraine, scary indeed, and weird enough to justify photographic evidence.

It’s raining here, which doesn’t change much. After looking at pet food ingredients for the first time ever, my husband is in revolt against the dog’s feeding regimen (ingredients: beef, beef hearts, carrots). We discussed the way in which the dog behaves toward the squirrel (aggressively) who has taken up residence outside the living room window, and how not even ghee and basmati rice will quell the dog’s aggression. No, this is just the normal state of things between dogs and squirrels, and it always has been. The dog and the cat are my husband’s first ever pets, but he grew up in the south of France, where his family slaughtered their own hogs, and where his first job was in a chicken processing plant. So I expect him to be a bit wiser in the ways of this particular world.

I am going to bake cookies because Thanksgiving and Easter are the only holidays when it is socially acceptable to whip up vast amounts of yellow frosting, and I swear that yellow frosting tastes much better than any other color, except for pale, pale, blue. My sister agrees precisely. It’s a weird sort of synesthesia. And that, I suppose, will be the extent of the excitement here today.

Today I am Thankful for...

Today I am thankful for Erin, who was the first person who advised me I might be more comfortable when medical professionals stick things up my cervix if I take a valium or two.

Yes, today was transfer today.

Before we left I took the puppy for two long walks in the hilly neighborhood. It was a sunny morning, and I tried to soak up the vitamin D.

Just before we left the house, I drank 8 oz. of water with 5 mg of valium. I drank another 12 oz. in the car. Apparently, if one drinks at least 24 oz. of water, one's bladder will be full, and this makes the actual transfer easier on both one's doctor and one's cervix, though not one's bladder.
When we arrived, I iced my right hip with a bag of frozen edamame. (I used our hot and cold pack yesterday for my left hip and forgot to freeze it.)

Then I went into an examination room, and a nurse gave me the progesterone shot and took my vitals, and then my acupuncturist came in and gave me a treatment. Then I took another 5 mg of valium and drank some more water for good measure.

Then I put on a gown over my sweater, and booties over my socks, and one of those really attractive surgical shower caps that is so attractive it will soon be worn by people such as Gwyneth Paltrow (who got pregnant by accident, and not through a process involving over 100 needles.)

My husband dressed in scrubs and booties, and he got a little cap like surgeons wear, and it gave playing doctor a whole new meaning.

But then the doctor came in waving a photo of three clusters of white circles on a black background and a detailed chart listing the health, progression, and quality of our embryos.

I won't bore you with the details of the chart, but I will say that the photo was of three of our best embryos. One of them looked like a daisy, which the doctor explained was really lucky photography, since all of them were close to perfect, and all of them develop in three dimensions.

We had already decided to only transfer two embryos, and we again reminded the doctor of this, so the third one in the photo will be frozen along with several others.

Then we went into the "procedure room" and they got me all set up in the stirrups, which was somewhat painful because now both of my ass cheeks were hurting, and then the doctor whirled around on his stool and revealed a window behind him.

"Before you lie back," he said, "we're just going to talk to Matt for a minute." Matt is the embryologist.

The doctor pulled up the blind covering the window and pulled the sliding glass door to the side.

"Two embryos for Nayla Joseph," he said.
"Just two?" asked Matt.
"Just two," said the doctor.
In case you were wondering, the answer is yes, it was almost exactly like the transaction at a drive-though fast-food window.

Then they did their transfer thing, with a "special catheter" and ultrasound visualization. The doctor and nurse complimented me on my very full bladder, and then applied pressure directly on that spot.

I looked at the ultrasound image on the screen and saw what I have learned is the thickened uterine lining. Then, as they threaded the catheter in, I saw two bright spots in the center of the lining.
"There they are," the nurse said.
"I see them," my husband said.

The doctor lowered the head of my table and raised my legs.
"This is the voodoo," he said. "There is no evidence it makes a difference, this raising your legs and putting you on couch rest, but it makes me feel better."

After my husband and the doctor discussed his prescription for a Caribbean vacation for us, I was allowed to empty my praiseworthy full bladder and head back to the examination room for the second acupuncture treatment.

So thank you, Erin, for the suggestion of valium.

And now, back on couch rest...


Needle Count
Take original total of 98, then add;
2 progesterone-in-oil shots
14 acupuncture needles for pre-transfer treatment
15 acupuncture needles for post-transfer treatment

Total so far- 129 needles.

A Pain in my Ass and Other Obsecenities

I went to my doctor's office today to have my first progesterone shot. Most IVF women have their partners administer this intramuscular shot, but I chose to leave my loved ones out of it, largely because the instruction to insert the rather thick needle in the muscle of my upper outer buttock with a sharp, dart-like motion made me nervous. I didn't want to be anyone's guinea pig for this kind of stabbing.

The nurse had me lie down on my side, drew up the progesterone and did use the previously mentioned sharp-dart-like motion into my left "hip." (Hip is the euphemism of choice for upper outer buttock.)(If you are really interested, you can see the actual injection process by clicking on the Intramuscular Injection Lessons video at Village Fertility Pharmacy.) It felt like what I imagine a wasp sting might feel like. The pain dissipated after a moment, and I thought that was going to be it. I made plans with my husband and mother to go out to dinner after one last pre-transfer trip to the gym.

I went home and didn't think about it for a while. My mother was also feeling the stir-craziness I mentioned earlier today so she suggested we go to the local mall. It was three o'clock, and already getting dark. It was raining. None of these things were helping with my mood.
But for whatever reason, at 3 o'clock, roughly 5 hours after the shot, my left hip began to hurt. It started as an ache, as though I had done too many lunges, but by the time we go to the mall, it felt like someone had punched me. I could barely walk. I sat at a coffeeshop, drinking decaf for two hours, while my mother enjoyed some well-deserved time away from the house.
On the way home, my hip was throbbing. The GPS suggested, politely, that I take the highway instead of a regular road, and I screamed FUCK FUCK FUCK while laughing and crying simultaneously.

My mother was unusually quiet.

We pulled into the driveway at the same time as my husband, so I let him carry everything inside. Then I took off my raincoat, went into our room, and changed into the following outfit:

1. brown fleece pants
2. pink Ugg boots
3. red wool sweater
4. aqua cashmere robe
5. sheepskin-lined gloves

I was still cold. This may be a symptom of living in Oregon, and not a symptom of progesterone-in-oil.

Then I took two extra strength tylenol while my loved ones discussed the better method for supplying a heating pad.

My husband reminded me that I acted with the same level of crazy last time I went on progesterone. I have only the vaguest memory of this. Perhaps someone was slipping me some Versed.

Retrieval Day

Wednesday was Retrieval Day. To describe what happens on retrieval day, I will quote from The Couple's Guide to In Vitro Fertilization by Liza Charlesworth:

"A special syringe is inserted through (the) vagine and it reaches to her ovaries. Then, guided by ultrasound images, her RE gently sucks the mature eggs out of their follicles."

I quote because unlike Erin, I did have the benefits of Versed. I remember going into an examination room and changing into a gown. I remember my husband leaving to go do his thing, and returning to comment on the poor quality of magazines. I remember the anesthetist coming in and putting the IV in on the first try. (For this, I recommend insisting on a local anesthetic before they stick you.) I do not remember how I got into the operating room, but I do remember being there, and everyone saying hello and then the next thing I remember is that my mother and husband were there.
"What are you doing here?" I said, "You're not supposed to be in the operating room."
They both laughed, and the nurse laughed. The edges of the room were blurry, so I didn't feel any particular motivation to keep my eyes open.
"We're not in the operating room," my husband said. "It's over."
"She probably won't remember much of this either," said the nurse.
"So now's the time to admit anything you don't want her to remember," said my mother to my husband.
"Honey," he said, "I have a confession. I am having an affair. With our puppy."
My mother laughed. "You know that the shepherds in Sardinia used to have affairs with their goats."
That is when the doctor walked in.
"We are talking about having sex with goats," my husband said.
"Oh, well, now is the time, if you don't want your wife to remember," said the doctor, not skipping a beat.

Other Retrieval Side Effects:
--Some pain, but nothing terrible. Kind of like really bad cramps. I only took one Tylenol 3 and was then able to switch to extra-strength Tylenol.
--A profound craving for pineapple juice and mashed potatoes.
--A dream set in a combination gas station/Indian restaurant in which one of my husband's colleagues was paying me in hundreds for the cryopreservation of his embryos. He only had the first hundred because they were going through a divorce. (Is this the equivalent of Erin's Aaron Neville?)
--Craziness of the Stir Variety, brought on by my mother's panopticon-like enforcement of my doctor's directive that I be a "couch potato" for 24 hours after the procedure.

The puppy, barometer of my emotions, has started running around like crazy, jumping and nipping and failing to observe the established conventions of excretion. Or maybe he is trying to claim my husband for himself.

in keeping with the theme of the day...

I have been in an exceptionally good mood today, because Nayla is having a long awaited happy procedure, and I think I am experiencing vicarious relief at it (the procedure) being over. I hope it has gone well. The last time I was faced with being given Versed was for an upper endoscopy (this visualizes the upper esophagus, which is very roughly located a little above the sternum.) About a year ago, I had decided to undergo this fascinating procedure after one episode of vomiting blood, combined with my mother’s diagnosis (a few months later) of esophageal cancer. Spoiler alert, but there was no problem identified with my esophagus. We suspect I was taking too much Alleve for a running injury, and not eating enough…food. In general. But in retrospect, I like the vomiting blood incident, because this, combined with the whole pupil dilation thing that happens with my migraines, does put me in the prime category of mild demonic possession. All I’m missing is a penchant for the uncontrollable eating of spiders.

In any case, the procedure itself, which involves swallowing a thin tube that contains a camera, isn’t painful, but it is distressing to many people. But I found the idea of Versed, one of the drugs routinely administered during the procedure, far more distressing than swallowing a silly tube. Versed is not really a painkiller, and it doesn’t really induce unconsciousness. Instead, it’s an amnesiac, and here I have to pose the question: what is it that is going on that one might not want to remember, and if such things are occurring, shouldn’t one be given more anesthesia, local or otherwise. An upper endoscopy is not supposed to be painful, and a *just in case* dose of intravenous Percocet is generally administered, but if some horrible slip up is going to happen, or if I’m going to find myself in a disturbing amount of pain, then my goodness….I don’t want to repress it. I pay regular visits to a psychiatrist for the very purpose of ensuring that any and all trauma in my life is highly visible and addressed. A friend of mine who knows about such things insists that this is one of the great human fears, the inability to recall conscious moments of one’s life, and that idea certainly terrifies me.

In the end, the procedure was uneventful. I took the reasonable route and explained to the doctor that I did not need Versed, because I don’t tolerate it well. That seemed like a good explanation and was mostly true, in the existential sense. She wasn’t wild about the idea, but judging from the goodwill I suddenly felt towards everyone after the IV insertion, I think they bumped up the Percocet level. Not only did I not have Versed, but I remember watching the entire procedure on the television monitor, and that Aaron Neville was playing in the procedure room, and dear God, I am grateful to not have that floating around in my subconscious.

Nayla, if after today you have any previously unknown songs in your head, it’s not a side effect of the fertility drugs. And I’m hoping things went well, and we hear from you soon.

98 Needles

Some doctors like to make conversation while they are doing things that make you physically uncomfortable. I always thought this was to distract you from the unpleasantness, to relax you. Apparently some doctors are just bored, or particularly curious about their patient's presentation of the human condition. Because on Monday, while I was having a particularly uncomfortable transvaginal ultrasound (physically), my doctor was asking my mother a series of detailed questions about my father's illness, medical care, and death. He asked about our end-of-life decisions, and whether the doctors involved approved of them, and he asked about my mother's concept of life-after-death. All while using that transvaginal ultrasound probe to measure and count the number of mature follicles. As you can imagine, it was all very relaxing, just like the week in the Caribbean I deserve.
Well, at the end of the appointment, my doctor gave the instruction for me to give myself a trigger shot of HCG and scheduled my egg retrieval for 9 a.m. Wednesday. That is tomorrow.

I spent part of today stocking up on ginger ale and crackers. Blessedly, while I did have acupuncture today, I did not have to give myself any shots. Such freedom.

Send fertile thoughts, if you have them to spare.

As of today, the needle count is as follows:
24 Lupron shots
5 blood draws
11 Repronex shots
9 Follistim shots
48 acupuncture needles (in four visits)
1 HCG trigger shot


Total to date: 98 Needles.

tapeworm, yes, diapers, no

After spending the weekend in a tiny high altitude Nevada mining town where all of the grown-ups were drunk and attired in period costume (a little like the renaissance fair, except with sidearms), where the highlight was a visit to a medical device museum in the basement of a Chinese restaurant, yesterday we retrieved our pets from my mother, who has now started to refer to herself as “grandma,” in the third person, in reference to the dog, as in, “grandma took you shopping for new toys at the PetSmart, didn’t she?” or “you are going to miss grandma reading to you, aren’t you,” and even, “your mama doesn’t cook for you like grandma does, does she?”
I texted my sister immediately. Filial consensus: this must stop right now.
There was silence in the car on the drive home, and it was not the comfortable, easy silence of a happy reunion with one’s pets. Instead it was a silence of deep discomfort. I know my mother is driven to behave this way believing as she does that for the indefinite future, her babysitting subjects will take heartworm medication and stalk houseflies. And all day, I’ve considered calling her to discuss our pending IVF plans (we haven’t talked too much about them since my father died), but the truth is, I would much rather just be pregnant, and not discuss the details with her. Mostly because in the past, she’s not exercised discretion in her conversations with others, and her lapses have resulted in near strangers asking me about my cervical patency and my husband’s semen analysis. Ok, maybe not near strangers, but I have certain cousins who don’t even know what my natural hair color is, for goodness sakes. Ones who have strong suspicions that infertility is linked to the consumption of organic produce, or maybe living west of the Mason Dixon line. I don’t know. If I don’t find a form letter, Dear Parents, We are undergoing IVF, please neither ask nor disclose details, on Google soon, I’m drafting one myself….

IVF: The Musical

I'm not kidding, IVF: The Musical is in progress. This is what my doctor told me today as I was sitting in his office wearing a sweater and a square of paper. He has commissioned two local artists to write a Broadway musical about IVF. We spoke at length about artists and what motivates them and why it might possibly be taking them more than 18 months to complete the muscial when they are being paid by the month.

While 90% of today's conversation was about said musical, I did get some information about my IVF protocol. My estradiol level, which, when someone is not doing IVF, should be 34-400 at mid-cycle peak, is over 3000. The doctor seemed to think this is good news. It may also explain why I feel like I am carrying a carton of chicken-eggs on each ovary. We are still on schedule for a Wednesday retrieval and a Saturday embryo transfer.

As of today, the needle count is as follows:
22 Lupron shots
4 blood draws
8 Repronex shots
7 Follistim shots
36 acupuncture needles (in three visits)

Total to date: 77 Needles.

Death, Dog, and Taxes

After unsuccessfully trying to explain to my husband why he really does in fact want to drive fourteen hundred miles to BrokenArrow, Oklahoma, for Thanksgiving, in our not overly large car with the dog and a wife who once managed to leave the entire state of Texas off an itinerary to which it rightfully belonged, he was able to pull the trump card of, well, employment. (And no, this was not an excuse. My husband likes my family, in a Margaret Mead/Noam Chompsky sort of way).

And so because in the estimation of United Airlines, the dog does not fit under the seat in front of us, and because we waited too long to use one of the three boarders who are recommended by friends just as neurotic about their animals, we are spending Thanksgiving alone. Well, not technically alone, but it will be the first Thanksgiving I have not spent with my parents. I have tried to forget the one last year, when my mother couldn’t eat anything, not even strawberry Ensure, when I caught her halving her Xeloda dosage, because half of the chemotherapy regimen, she reasoned, would be better than no regimen at all. I still have somewhere the phone that I broke, very intentionally, on the tile of my kitchen floor. An interesting fact: there is a California misdemeanor code that addresses the intentional destruction of an electronic telecommunication device, geared, no doubt, to situations in which one is calling for help, not necessarily where one is calling their sister in Chicago, warm and removed from the craziness at hand, for help of a different sort. After that, I took Family Medical Leave, and watched my mother take the prescribed dose of her chemotherapy. And mercifully, I’ve almost forgotten about the pale green plastic tray with the Thanksgiving dinner in the palliative care unit, where my father was staying at the time. There is nothing more soul smothering than institutional holiday food.

So in light of the memories of yesteryear, I suggested to my husband that we take the time to go somewhere else, a neutral place with no memories of Thanksgivings past, a brand new rat cage in lab parlance, but that was gently vetoed, too. That’s because my husband is starting a consulting business next year and needs time to put certain things in order, which is actually a great thing, for about ten thousand mind numbing reasons that I’m not going to go into, but the upshot is that it makes infinitely better sense to do IVF after January 1, in the next tax year. And actually, the clinic we are going to use closes for two weeks in December to do something to the embryology lab- clean it, recalibrate the instruments, I don’t like to think too much about the details and the variables regarding what might not correctly put back together, and I’m too superstitious to schedule something immediately before or right after, so….fine by me.

Needle Count

Erin suggested I actually keep count of the number of needles involved in this cycle of IVF instead of just waxing poetic (or whining) about it. She and I intend to use this as cocktail party conversation. Perhaps this sort of inclination has something to do with why we spend our time corresponding on the internet instead of getting invited to more cocktail parties.
So, as of today, the needle count is as follows:
18 Lupron shots
2 blood draws
4 Repronex shots
3 Follistim shots
26 acupuncture needles (in two visits)

Total to date: 53 Needes.

I was all set with today's post

about my French husband’s thwarting of our Midwestern Thanksgiving plans, and how this time last year I broke one phone and at the same time a CA misdemeanor. But then I read Nayla’s post.

It’s so hard to do something to honor the those who are not here, because you never really know what someone else would want. Years and years ago, my mother picked out hymns, flower arrangements, New Testament passages - but that’s my mother. Other things I’ve come across this year…Jane Kenyon has some wonderful and beautiful works, such as this, and my God, especially this, a poem one of my father’s friends sent me just two weeks ago, one so deeply personal and relevant, I might be able to say more about it in thirteen years or so. But therein sort of lies the difficulty, it’s almost impossible to find something appropriate. Finally, I wanted to post Leonardo Alishan’s The Black City, but the text is no longer on the internet; (and maybe that’s a good thing- I think it’s a beautiful and hopeful poem, but nobody else has ever agreed). So Nayla, I could not think of the right thing to say, and I have to tell you- I’ve been reading a lot of this sort of thing lately. It’s difficult to find the right balance of sadness and beauty- and to know what honors a person’s memory. And then I remembered something I read last night in a writing workshop, something with airplane travel and crankiness and curly brown hair, and it has been on my mind ever since, that and your initial post, about dying and being alone, and what I want to say to you is that what I read last night was about a family that was the opposite of alone. They were separated in some ways, but they were not alone. And I bet there is room for friends. It was about many other things too, but this is the thing that stands out today. I can imagine how difficult it was yesterday to read and reread and then post that work for Week 2 on the same day such sad news came, but I think that it’s sort of a gift to them that you wrote it, and maybe in ways less easy to define, a gift to you too.

I am not a Chemist

I admit, I did not appreciate my belly. It wasn't always perfectly flat, or perfectly toned. But it was mine.
Now, my belly is unrecognizable.
It started with my surgery, which left a set of scars and a belly button that looks like it is frowning. The belly button is frowning because the doctor went in laparoscopically, and the way they minimize the total number of scars is to go in through your belly button. There is no scar on my belly button, but the skin did not heal the way it was, and now my belly button is sad. It is pessimistic. About four inches below my belly button there is a one-inch scar, like an upside-down crescent, which also looks like it is frowning. There are two small scars about eight inches apart, and between my belly button and this new upside-down crescent. If you connected the three scars and the misshapen belly button, you would make a diamond. And unlike my emotional state, which can be brightened temporarily by, say, a puppy with an ice cube, these sad scars are permanent.
And now, my three-shot a day regimen is furthering altering the tectonics of this landscape.
Allow me to get you up to date. In the mornings, I am taking 150 iu of Repronex. I wipe down all the vials with alcohol preps and unwrap one very long needle-syringe combo and one short needle. Using the very long, and, I must say, intimidating needle, I inject 1 ml of sodium chloride into one vial of powder, and I let that dissolve, and then I suck that mixture up with a needle and inject it into another vial of powder and let that dissolve. Then I twist off the long needle and twist on the short needle. At various points in between, I am holding my needle and syringe up to the light and whacking it with a pen, trying to get the air bubbles out and thinking of the movie Trainspotting. I am not sure what would have happen if I missed an air bubble, but I am sure I do not want to find out, especially since there was an episode of House that posited that such a thing could kill you, even if you previously gave voice to Darth Vader.
Every time I do this mixing and wiping and switching needles, I think of my tenth grade chemistry teacher, who told my mother that I was a terrible multi-tasker, and that this meant I would never be a chemist.
This Repronex shot seems to be the one my body likes the least. I have now given myself three shots. I am supposed to give myself a shot somewhere in the region below my belly button, avoiding a two inch radius of the four points of the diamond of scars, which, as you will recall, includes the belly button. The problem is that every time I give myself one of these shots, a raised, red, swollen patch develops, measuring about 4 inches in diameter. I have three of these so far. For Erin's amusement, I took out a tape measure and measured the available terrain. From hip to hip, I've got 14 inches. From belly button to crescent scar I only have 3.5 inches. And every night, I give myself two more shots, the previously mentioned Lupron, and 225 ius of Follistim. These other two shots don't seem to be causing any problems at the injection site, but if these raised, red patches don't start to subside, I'm going to run out of willing injection sites.

Will Someone Die Every Time I Do IVF- Part Two

Currently available evidence suggests the answer is yes.
Just two weeks ago, I found out that my friend Virginia (better known as Gigi) was going into hospice. I asked the question "will someone die every time I do IVF" because it seemed ridiculous that, after finding out about my father's terminal cancer the week of my first IVF retrieval, yet another loved one would succumb to cancer while I try to create life.
Gigi died tonight, peacefully, surrounded by her nephew's family.
I'm finding it difficult to access any additional grief. As my mother put it, when the tide is already so high, a little more water doesn't even matter.

Come to think of it, I should have asked her a question or two

Last night I met a French psychic. Not to be confused with the Northern California garden variety, who tend toward natural fabrics, billowing jumpers, sage scented shampoo, this one had deal with the devil shiny hair, weighed about as much as my bichon, wore Jimmy Choos, and if she has a crystal ball, I'm betting it's a Swarovski. Myself, I was wearing brown with black (again) and the ergonomic utility of my boots was unambiguously reflected in their aesthetic. I was lugging a brown paper REI bag that contained two packages of tube socks and one recent guide to the Pacific Crest Trail, and this sort of get-up is a good example of what usually happens when I meet any of my husband’s cosmopolitan friends, but so be it. Nobody has died yet. In any case, I was overwhelmingly relieved to hear that my new friend shared none of the similar pretensions I’ve grown used to, having been born in Northern California in the mid 1970s and having lived in a county that hasn’t easily parted ways with that particular era. We discussed a nearby mountain, rumored to be a place of high spiritual energy. But it’s cold this time of year- did she find hiking a problem? Doesn’t hike. Do they have to reserve the campground in advance? Doesn’t camp. I couldn’t tell you why, but I like these things in a psychic. Which isn’t to say that I have an opinion on the matter of mind reading or prediction, and then something interesting happened. The other three people at the table were discussing Sarkozy the newlywed, and his rumored affair with a cabinet member, a forty-four year old woman and the mother of a small infant, paternity undisclosed. My French is not passable for navigating the cheese isle in the supermarket, and as far as champagne goes, I buy what is cheap and cold, but I managed to follow the conversation, albeit four steps behind (which I recommend doing some time because it makes for an interesting narrative), when my new friend turned to me and said something to the effect of, “...she (mistress to the French president) is forty-four. You are a woman, you know. A woman over forty does get pregnant accidentally,” except she said it with a voice that would liqufy concrete.

And shortly thereafter we were all distracted by my ability to drop daal, roti, rice, from three dishes, nearly simultaneously. I blame telekinesis.

Cold Feet, More Needles, and the Idea of Eleven

A few days ago I went to my first appointment with my new acupuncturist, and was contemplating the number of needles to which I am willing to subject myself to have a genetically-linked child. If I had a more mathematical bent, I might actually try to estimate this, but instead, I like to think of it as the overwhelming number it is, like stars in the sky or plankton in the ocean. Actually estimating the number might make it seem less overwhelming for some people, but I prefer to simply forget about the needles until just before I have to deal with them. This must be why I forgot about the number of blood draws there are for IVF. I forgot that the skin on the inside of my elbow starts to form a little scar on the phlebotomist's favorite spot.

I have been giving myself shots of Lupron for two weeks now, and I am scheduled to begin the follicle-stimulating drugs tomorrow, so I had the pleasure of going to the doctor to have my ultrasound and bloodwork.

Today was only my second blood draw of this cycle, and I have a lot more to come. I find it comforting that the phlebotomist is friendly, and named Rihanna, and admits to being afraid of all needles that do not leave a ink or a piercing behind when inflicted on her. I also appreciate that she remembers to use a butterfly for the blood draw, because no matter what phlebotomists say, the butterfly method is less painful and results in bruising less often.

After the blood draw, I went into an examination room, where I undressed from the waist down while my husband sang what he says is the music one find in porn. This, as you can imagine, made me feel very sexy, particularly as I left on my socks on, climbed on to a very erotic examination table and covered what the truly educated term the vajayjay with a square of paper.

And to be honest, I considered getting off the exam table and putting my Ugg boots on over the socks, because my new acupuncturist reminded me that cold feet are very bad for fertility, particularly for someone like myself, with a cold nature and too much dampness in my system. My acupuncturist in California said this meant I needed to wear socks constantly, and that was California, where it is temperate and dry most of the time, and the question is, if I just had to wear socks before, what will it take to stay warm, dry, and fertile in Oregon?

Before I could act on this idea, the doctor came in and the three of us had a conversation about various parts of the protocol while I modestly crossed my legs. Now, dear reader, if you have not been through fertility treatment you may find this a little strange. Let me put your mind at ease At this point, so many medical professionals have had a look at my vajayjay, I didn't even think about the square of paper until the doctor moved to the side of the room so as to better address both me and my husband, and I realized that my backside was fully exposed, because I was wearing a sweater and a square of paper, and not a robe, or some other garment. Anyway, I chose to let this issue go, because what with the infertility, and the death of my father, and the fact that my mother is now staying with us and my in-laws are visiting, and the chemical menopause symptoms of persistent headaches and weepiness, the indignity of a bare backside is really not worth my time.

After we had our conversation we went on to the real reason for the doctor's appearance: the ultrasound. (This is the thing that Erin's doctors should have been doing to monitor her during all her IUIs.) This is how today's ultrasound went: The doctor pushed a special ultrasound probe up the aforementioned vajayjay and the three of us took a good look at the ultrasound image of my ovaries and the associated follicles. No ovarian cysts, which is good. And eleven developing follicles on each ovary. "You seem," said the doctor, "like a woman committed to the idea of eleven."

This afternoon, I got a call from the nurse saying my bloodwork showed a level of estradiol of 38, which means I'm ready to decrease my Lupron for today and start my follicle-stimulating shots tomorrow. Next appointment: November 11.

A Tale of Two Clinics

There are two large fertility treatment centers in the large metropolitan city in the neighboring county. The first is affiliated with a large teaching hospital, and the second is a private fertility clinic. Their ranking in most areas is the roughly the same, and the price of treatment is also similar. I am insured by two excellent PPO insurance carriers, (who probably won’t be sending me holiday cards this year) but neither plan offers fertility coverage.

My initial fertility work up and first round of IUIs were done at the large teaching hospital, mostly because my primary care doctor belonged to the IPA affiliated with the hospital. There are a lot of good things to say about that center- the staff physicians were excellent, the lab was excellent, and a wide range of specialists collaborated with the center to provide ancillary tests and analysis. As I progressed through treatment, however, I encountered some issues that were so serious that my husband and I decided to leave the large hospital and pursue treatment at the private center. Specifically:

Teaching hospitals have a dual purpose: to treat patients and to train physicians, (also to conduct research, more on that in another post) and those activities generally amount to the same thing, as far as patients are concerned. You know the doll who gets yanked off the shelf for the community CPR class? Congratulations, you’re that doll. And while I am the first person to appreciate that physicians have to start somewhere, my personal experience, as a CPR doll was, how to say not exactly, exquisite. Here were two problems that could have been avoided:

- I researched my Reproductive Endocrinologist (RE) a lot, and luckily enough, she accepted me as a patient. So far, so good. However, she was not the clinician who performed most, or any, of the actual procedures, and probably more importantly, she was not the physician who monitored my progress. Or, at least, not until I developed multiple cysts after several months on Clomid- cysts that should have been monitored prior to every procedure, and were not.

- There’s a new commercial for a pregnancy test (I have no idea if it’s a new pregnancy test), with the byline “1 in 4 woman can misread a traditional pregnancy test.” Ok. Fair enough. I suppose that under the right circumstances, 1 in 4 people can misread nearly anything, so I’m not going to deconstruct that statement. But the Ovulation Predictor kits suggested by my RE….good lord. Now that was rocket science. I need to devote an entire post to explain why this was so. But in any case, it is for this reason that the private clinic doesn’t use them at all, instead relying on ultrasound monitoring to appropriately time IUIs. Also, the private clinic uses ultrasound monitoring to look for the development of cysts. Also the private clinic uses ultrasound monitoring to ensure that CLomid hasn’t decreased the ovarian lining to a thickness that would not be conducive to implantation. For those three reasons, my IUIs at the teaching hospital were pretty much pointless. I think I should devote another blog post to why exactly one probably doesn’t want to go through pointless IUIs, with the adroitly named TomCat catheter.

The Bitch is Back

I remember hitting puberty early, hitting it like a great brick wall of rage. My mother could offer me a cracker, and I would retaliate like she was hiding WMDs.
And here I am, back in a tsunami of hormones, and my mother and I are living in the same house again. And I have one piece of advice. Learn, if you please, from my poorly-behaved example:

Do not start Lupron and then have your mother move in with you the next week. It will not be good for your relationship.

death and the goldfish

I’ve been thinking a lot about something Nayla said in an earlier post, about how she isn’t sure whether it’s grief or Lupron that has caused her to forget how to open her front door. This is a completely bizarre time in life, and I wonder how uncommon it is. The mid to late thirties are, I guess, considered to be at end of the childbearing spectrum, but certainly still in the range of childbearing years. And most women will not experience infertility, per se, and in population groups where women have many children, childbearing is normal even into early forties (google search: Mennonite, childbearing). I suppose the difference here is that those women often already have several children, so are not dealing with the possibility of having no children, of never having children, at the same time they are dealing with ill or dying parents. Maybe it’s a little like ear piercing for children- everyone prefers to do both ears at the same time, so nobody has second thoughts halfway through. If I hadn’t already decided to have children before my father got sick, I don’t know that I would have the resolve to go through fertility treatment at this point in the game, not when I’ve seen what can happen, so to speak. Which is also bizarre, because it’s not as if I’m a four year old who doesn’t understand about death and what happened to the family hamster.

A bird in the hand is worth two in the bush

aka

A living dog is better than a dead lion, Ecclesiastes IX


Yesterday, my small bichon frise found a (considerably smaller) bird on our front porch, in the same area where several other small birds have landed after flinging their small bodies against the unshuttered window on the back door. I would’ve liked to have taken a picture of Henri lightly prodding the little thing. It was sort of like something out of a Walt Disney movie, but it probably could have gone Tarantino pretty quickly. Luckily, disaster was averted and the bird, able to hop and flap his wings, but doing something with his head that was concerning way probably had some sort of head injury. You could almost see the little Tom and Jerry cartoon concussion stars. And luckily, bless their 501C3 tax status, Wildcare was accepting small patients that day.

Ok, I’m not the sort of person who would wrestle a bird, even a lovely little songbird, from the paws of a coyote. Nature is, after all, nature, and she must do things for her own reasons, or however Faulkner put it, but this wasn’t an act of nature. This was an act of my stupid plate glass window, one that isn’t clean enough for my neighbor’s aesthetic but apparently not dirty enough to prevent small winged animals from smashing into it. A plate glass window is the natural predator of absolutely nobody.

We didn't name the bird. I have no idea what type it was, a sparrow or a songbird or a waxwing. It was a brown bird. There are no ornithologists in my house.

And I guess today I’m overly sensitive, especially towards small and probably dying things. At the risk of disillusioning the many medical insurance companies no doubt clamoring to insure me, I’m going to come out and say what my friends, family, postal service carrier, and Primary and Secondary insurers already know: over the past few months, I have taken anti depressant medication, and today
is my eleventh day of not taking Wellbutrin, prescribed for depression, what with all the infertility and dying over the past two years. Obviously, nobody should put that sort of information on the world wide web. Although, I’m certainly not alone- a pretty non trivial percentage of my demographic will utilize some sort of psychiatric medication intervention. And in my case, while the collective benefits of 300 mg. of Wellbutrin outweighed the side effects, the withdrawal period has sort of thrown me for a loop, or at least that’s the best way I can describe what seems to be going on in my head, the sense of balance turned around and around in a spherical spiral pattern. My equilibrium normalizes and then just as quickly falls away; so far today I have walked head-on into a concrete pole and missed two porch steps. The ability to focus is there, and then it is not. I have two small patches of neuralgia, one on my lower rib cage and one in the exact middle of my spine, and even the brush of my cotton shirt is painful. But mostly I'm more emotional than usual - not on the level of crying while line at Rite Aid, or pulling out old photo albums, but I’m doing what I can to avoid the evening news and have definitely put aside The Lost Dog, None of this is to say that the withdrawals detract from the collective benefit of taking the drug, and no way would I have wanted to go through Wellbutrin withdrawals while dealing with chemically induced menopause, no thank you, psychotropic medication withdrawal and Lupron are, in the parlance of pharmacologic epicure, lattes and pinot noir and altogether bad news in the same sitting.

Now, this was the right decision for me (and, presumably, for the recipients of the 118 million antidepressant prescriptions given to Americans in 2005). It was also my personal decision to avoid getting pregnant while taking that drug. And I’d like to say right here that plenty of women make different decisions, who do take MAOIs and SSRIs while pregnant, and the literature is not conclusive on this. My own psychiatrist believes that outside of the precious first trimester organ formation period there is negligible harm done with certain anti depressants. Although this recent Medscape article sort of disputes that. I’m not saying that another person couldn’t have gotten through a similar experience with prayer, or yoga, or meditation, dowsing, interpretive dance, whatever. I won’t interrogate the subject further.

Instead, I'll settle for being the living dog.

Addendum: the intake worker at San Rafael's Wildcare reports that the small brown bird of the morning is a Thrush

Yet Another Reason to Eat Candy Corn

I was so pleased to see Erin's post about National Candy Corn Day just after I received a package full of fancy Halloween candy from my in-laws. I think this series of events sparked my epiphany about why my shots have been more painful this time around--I am too skinny.

I am not bragging about my current weight. The last time I started fertility treatments, I felt stronger and healthier. My posture was better. I was also several pounds healthier. I started losing those pounds during my three days in the hospital during my miscarriage, when the doctor kept me on a regimen of morphine and ice chips because of the possibility of emergency surgery. After I left the hospital, I did not exactly maintain an appetite while watching my father vomit from chemotherapy and waste away. And finally, for the last ten days of my father's life, my mother stayed in his room with him around the clock, relying on the kindness of strangers (and friends) to bring us a meal or two a day.

(Note that I do not recommend this as a weight loss strategy.)

I am not the healthy, strong, toned person I was before I started fertility treatments the last time around. And most importantly, I do not have the same amount of belly fat.

So when you give yourself the subcutaneous injections, what you are doing is pinching the skin and fat of your belly (avoiding a two inch radius from your belly button). Today, I finally realized that I just don't have as much to pinch, and that is making the process more painful. So I will now feel free to eat a little candy corn on Halloween, in the hope that by the time I am up to three shots a day I will have gained a little more belly fat without increasing my risk of gestational diabetes.

October 30 is National Candy Corn Day

No, really, it is.

Partly because Nayla started this with her previous alliteration, and partly because I just like the sound of the word, "twinning," (a nice combinating of turning and swimming, sort of uterine verbs), and I'm sure not in small part because the RE keeps quoting at me the new and fantastic success rates for single embryo implantation (with is at least one embryo too few, by my faithless standards), I've spent the morning reading this site, derived from this study

which posits that environmental factors might actually influence twinning rates.

No, by environmental factors, the study does not mean daily injections of gonadotropins.
I think this is an interesting reversal of those studies that use twins, who have the same genetic makeup, to measure the degree of influnces of an environmental factor.

And then in other news, my next internet search will involve the impact of vast amounts of Brach's mellowcremes on luteal cycle length. Corpus luteum is Latin for yellow body, which is accurate for cows, but not for human women, in whom the corpus luteum is actually orange.

the follistim pen and the feline

Follistim: the interpretive ballet

The Big Box of Needles and Drugs

The Big Box of Needles and Drugs arrived today. I cleared out a drawer in the refrigerator so the drugs would not get mixed up with the arugula and the milk.
Here is what is in the box:
Follistim
HCG
Repronex
About a million needles and syringes
Packages of individually wrapped alcohol swabs.
One container of very large capsules of antibiotics.
One container for disposing of needles and syringes.

I called American Express to confirm that they had accepted the charges for the doctor (nearly $9,000) and the latest shipment of medications (over $3000).

I do not want to swallow those pills. I do not want to give myself those injections. The puppy, barometer of my emotions, has retreated to his crate.
But, for the chance of having a baby before I am 38 years old, I will do it. I am committed.

Puppy Therapy

This afternoon, I was standing in front of our house, and I suddenly forgot which key opened the front door.
I kept trying the purple key, and finally my husband took out his keys and opened the door. And I said, "But I use that key every day!" And my husband had to take my keys and show me that it was the yellow key and not the purple key that opened the door. And then I suddenly remembered that in fact, I use the yellow key every day, and every day, it unlocks the door.

To what do I attribute this? I looked up the potential side effects of Lupron, and memory loss is not among them. Is it the grief? Is it fatigue? Is it a side effect of the persistent headache that is a side effect of Lupron? Is it the fact that last night's Lupron shot, which previously seemed fairly painless, was painful, even with use of my trusty icepack? Or is it the fact that today, I read a chapter of a friend's novel-in-progress that was all about the painful death of a parent from cancer and I spent the day having flashbacks of my father's last days?

But there is a great treatment for all of this sadness and discomfort and awkward, splayed hope.

There is a puppy.

We adopted him from a shelter a few hours away just before the first appointment with the only fertility specialist in town, after a really terrible few days of feeling sorry for myself. The puppy displays the typical exceptional cuteness of his kind, even while doing mundane things like sitting on a bookshelf or chasing a ball. This kind of entertainment is enough for the usual level of stress and sadness.

But for my case, I have self-prescribed a special kind of therapy. I give this puppy an ice cube, and hilarity ensues.

fertility work-up: the second time is twice as nice!

Nearly three years have passed since I last went through a fertility workup, and I am due for a repeat. The standard workup consists of a battery of tests. All things being equal, in terms of number of tests, simple blood analysis make up the majority. I couldn't give you an exact number, but I have learned that it's best not to count the number of vial labels that the lab tech exchanges for the lab requisition slip (one label per tube, at least three tubes per work up). Also-note that the pre test instructions are not theoretical. During my first work up, in my mid twenties, I made the mistake of having an FSH analysis (I think it was an FSH analysis, anyway) shortly after taking a dose of Clomid. I wouldn't recommend that particular course of action unless you are the bizarre sort of comedian who wants your ob/gyn to think you are a candidate for premature ovarian failure.

Certain other tests, including follicle counts with the craftily designed transvaginal ultrasound, (in the interest of not getting booted off Blogger, I’m not going to include a link) do not exactly rank high on the fun list, but can be gotten through. Others, such as the HSG, are rather unforgettable and I will in no uncertain terms drink bleach if I am made to repeat that particular test again. I will say, with regard to the HSG, that I object to the idea far more than the actual procedure, which was uncomfortable but not painful. Luckily, the only tests I need to repeat are the labs and the follicle count.

Because no test has ever indicated a definitive cause of infertility, there's not a good reason for me to worry about the results, which doesn’t mean that there aren't plenty of other shoddily constructed and weakly articulated reasons. I'm one of those people who subscribes to the idea that if you don't believe in the principle of induction, (not to be confused with a similarly named step in the IVF procedure) the principle of induction doesn't apply to you, much like ghosts for children or hell for athiests. I am absolutely aware that people who go around verbally articulating these things are irritating to be around, but by God, I've earned it, what with the rare cancer lottery and all. So just because a test has come back normal five out of five times, doesn't mean that, say, the sixth time, it's not going to indicate that I am not only in full-blown premature menaupause, but have contracted liver flukes and will any day now express a latent gene for supernumary teeth, because I've always had sort of questionable orthodontia.

All this is to say that I’m not having the tests re run until my next appointment with the endocrinologist, which will be in approximately 33 days +/-.

Long Long Lupron

And now a bit of the practical. I have started the Long Lupron IVF protocol.

For most people, this protocol begins with going on birth control pills, and I had already started to take them after a surgery I had to remove uterine fibroids in August. (The fancy name is a laparoscopic myomectomy.)

I have recently moved to a small town in Oregon, and there is only one fertility doctor in town. He uses the birth control pill and and an injectable called Lupron to get everyone in the current protocol on the same calendar. This allows him to organize his time so he can do all the egg retrievals and embryos transfers in the same week, which apparently leads to better results.

If you don't count the time on birth control, I am on day three of my protocol. If you want to know the nitty gritty of the process, here's my current nightly fertility regimen:

1. The birth control pill
2. A prenatal vitamin
3. A baby aspirin (the purpose of which is, I think, to increase blood flow to my ovaries.)
4. 10 units of Lupron in shot form (with a needle, not a glass.)

The idea is that this use of Lupron puts you into chemical menopause for two weeks before you start the other shots, the ones that stimulate the growth of the follicles that produce the eggs. Erin, are these the right verbs to use?



Chemical Menopause: "Egads," you exclaim. "The whole point of this is to beat menopause! To outsmart my infernal biological clock!" You might be agitated, and cranky, and you have not even started the Lupron yet. Well, I will share that so far, chemical menopause has not been as terrible as I feared. I don't know about you, but I mostly associate menopause with hot flashes. What I have had is more akin to the feeling you might get from a warm brandy. This is not a problem right now, as I am adjusting to a cooler, rainier climate here in Oregon and have not had alcohol since the day my father died. (One token glass of white wine with my mother at a restaurant, when she couldn't bear to head home to an empty house.) But the warm brandy flush might be alarming if you were not expecting it, or if you were giving yourself Lupron shots in Texas in August. The only other symptom I have so far, which has little to do with the weather, is a headache. Not a migraine, not a sinus headache, nothing too out of the ordinary. Just another hormonal headaches like all of the other hormonal headaches I have had in life. Irritating and persistent, but manageable. I have not had the crazy mood swings or nausea, or any of the highly unpleasant symptoms other women have reported on other blogs. But there is still time!

After all, it must be called the long Lupron protocol for some reason other than the charms of alliteration...

Will Someone Die Every Time I do IVF?

As you may recall, my father was diagnosed with stage 4 pancreatic cancer just after I went through my embryo transfer for IVF. And, as I started this process again, and tried to articulate the particular strands of trepidation I was feeling, the thing I was not telling people was that I was wondering whether someone would die every time I did IVF. To be clear, even though I am an only child, I don't really believe that everything in the world revolves around me. But I know about the circle of life, both from the Lion King and from that movie where death takes a holiday, and I know that usually, someone, somewhere is leaving this mortal plane when someone else is arriving via birth. Really, God, I get it. It does not have to be illustrated for me with such a direct connection as it was in the spring.

But apparently God, or the Powers that Be, or the Great Narrative Arc of my life feels otherwise.

Because I started my Lupron shots on Friday night, and today I have learned that another loved one is dying of cancer in the very near future.

Last Thanksgiving, while my parents were visiting us in California, we found out that a close friend of theirs, Virginia, was diagnosed with lymphoma. She had started treatment, but, with a variety of pre-existing conditions (including congestive heart failure), no one thought she had long to live. When I started IVF and my father was diagnosed, my mother and I were really not able to call or help or even really think about Virginia's condition. Luckily, she has a nephew who really stepped in. While my father was on life support and in his final days, the nephew moved Virginia to an assisted living facility near his house.

Now, Virginia has not had an easy life. Her first husband was a fighter pilot, and was MIA in Vietnam. She remarried a squadron-mate of his, and they had a son. When their son was 8, he was killed by a drunk driver on the sidewalk in front of their house. We met them a few years after this, and Virginia and her husband Bob took an instant liking to me. They took trips with us, to Hawaii, and the Caribbean and France. They wrote cards and called and spent holiday after holiday with us. And then, in 1991, when I was caught up in the whirlwind of college, Bob died of cancer. Virginia was alone. She did not have any siblings. She had lost both of her parents. Really, her nephew was her only relative. And we were the next closest thing.

A week after my father's funeral, I drove my mother down to see her. We had a terrible dinner in her assisted living facility, but she was happy to see us. She complained about her room; she complained about the food; she complained about how old and boring and lifeless her new house-mates were. Honestly, she didn't even seem sick anymore. She sent us out to buy some bottle of wine and some Doritos. And then my mother and I drove back up to my mother's house to continue the strangely sad and technical work of executing my father's estate, writing a new will for my mother, and preparing for the other major life transitions I was about to go through (including a surgery and a move to a different state.)

And now, just as I've started the long Lupron protocol for IVF, Virginia has moved to a hospice. There is a tumor in her spine and possibly one in her brain. She told her nephew that she is not afraid of dying, she is only afraid of dying alone. And he has promised her that he will be there for her.

And I will continue my protocol. I will not make plans to fly across country to see her, because, as my Reproductive Endocrinologist reminded me, I am not as young as I was six months ago.

And if Virginia does die alone, I will always feel I have failed her.

Nayla, by way of introduction

Nayla is a rare sort of person, clever and beautiful and uber articulate. I remember reading her fiction writing (even when my head was full of Clomid, a feeling not dissimilar from the one you get after eating confectioner’s sugar straight from the box) and being enthralled by it. These were during the days when a single digit countdown to atomic war could have put me to sleep.

Still, Nayla and I should probably not be friends. For the past two years, we have shared the same misfortune, one after the other, from fertility treatments to fathers with similar cancers. We've even had the same weird and complicated miscarriage. I mean, honestly. If I happen to get a rash on my face, or she hits a deer with her car, under no circumstances should either one of us share that information with the other, because the next week we are likely to find ourselves exchanging auto repair resources or the best type of antihistamine. It’s true that she’s lovely and charming and one of the most intelligent people you’ll probably ever meet, one of those people so clever and beautiful that you really don’t expect for them to be a nice person, in addition to everything else, but for the past two years, eerily similar crummy luck and statistically improbable travails have followed us. For that reason, and because she’s a more proactive person and certainly a stronger person, and going through active treatment right now, I expect her to change our luck substantially. No pressure, Nayla.

I’ve never met either one of Nayla’s parents, but she has a sort of generosity about her that you either have or you do not. My husband, who is French, translates that attribute “to be educated correctly,” and what he means by this is to be educated about the general way to go through life, how to look at people with kindness, and to remain gentle in the face of obstacles. I bet Nayla would tell you where she gets that from, and I’d agree with her, which I suppose touches on what we are trying to get at in these entries.

So while we’ve shared some past experiences I believe we both could have lived without, I’m grateful to be going through this particular one with her.

when you hear hoof beats

Don’t look for zebras. Unexplained fertility is a misnomer. It is a transitory point in time that comes after the failure of fertility treatments based on the educated guess of the moment. It’s the fall back when the injections, hormone replacement, hormone suppressant, radioactive dye insertion, catheter procedures and prodding and altogether too much poking around, fail. Sometimes there is a post treatment regroup, and it comes after this too, after you’ve tried the acupuncture needles, the boiled seed pods and east Asian herbs and possibly, if you haven’t disclosed your vegetarian status, gecko. It comes after you, a lifelong agnostic, have visualized your uterus to be a metaphysical white glowing nest of life, after you have publicly banned your husband from the spinning bikes at the gym, after you’ve taken the drain from the bath and placed it in the linen drawer, where it can’t be used to take hot water baths, that mortal enemy of male fertility. Behind every unexplained fertility diagnosis are the best guesses of the OB/GYN, endocrinologist, andrologist, urologist, mother, mother in law, inquiring neighbor, well-meaning friend. Unexplained fertility exists to prove Hickam’s dictum. And now, I can bid that diagnosis goodbye, good riddance, certainly a well-earned good luck, because a little over a month ago, I turned thirty-five, which puts me unambiguously in the infertility category of “advanced maternal age.”

How do you like them horses?

Infertility hasn’t consumed my life. In 2006, just as I was in the middle of a series of IUIs, my father, then sixty, who was probably my closest friend in the world, was diagnosed with adenocarcinoma of the ampulla of Vater. This is a bad cancer, a rare cancer, so rare that there is no real treatment protocol, a bona fide fascinoma. The current course of treatment for ampullary cancer follows the one used for pancreatic cancer. After a few months of the roller coaster that Nayla referred to earlier, my husband and I decided to delay our fertility treatments. And why not, after all? I had plenty of time. We adopted a shelter cat named Lola, and two years passed.

In the summer of 2008, three weeks before my appointment to resume fertility treatment at a large medical center in the neighboring county, my mother asked if I wouldn’t mind taking my sister to the airport. Our mother had a medical appointment that day, and might not be feeling so well after. My mother, a non-smoking, non-drinking, near vegan, has never been less healthy than a horse (that mythical creature) so I didn’t think too much about it. One week and a few days later, she was diagnosed with second to third stage squamous cell esophageal cancer, a rare cancer seen most often in heavy drinkers and smokers.

I am a congenitally pessimistic person. I’ve never quite been able to convince myself that lilies will bloom at room temperature, so I either buy them past the bud stage, or worry the petals until they turn a filthy brown and then lop over. Even so, I did not see this coming.

During the next eight months, my mother went through chemotherapy, radiation, and a certain surgical procedure colloquially referred to as “the mother of all surgeries,” while my fathers’ health declined precipitously, as the cancer metastized to his spine and meningeal layer. One morning in December, as I sat in traffic on Highway 101, my mother, in the passenger seat, vomited into the small plastic container that now followed her everywhere. I dialed AT&T directory assistance, and asked them to patch me through to the local hospice agency. That morning, on the two-hour drive to my mother’s chemotherapy appointment, I arranged for in home hospice.

Outside of the bay window of my parent’s house, there is a hummingbird feeder that has created a generational welfare state among the birds of our street. It’s a lovely thing to see in summer, above the green lawn, the American Beauties and the plum tree, but in winter we let the lawn go fallow, and bright red plastic of the feeder is something garish against the brown grass and bare thorns. Still though, I believe that the easy availability of sugar water has offset normal avian reproductive constraints, because hummingbirds visit the feeder year round, or at least they did that winter, when I spent plenty of time staring out the bay window, at the hummingbirds on the other side of the glass, the dead lawn and the desiccated rose hedge, the county road that is never quite maintained and the field beyond that, the jackrabbits and the pheasants and even, like an awkwardly timed joke, the Appaloosa horses kept by our neighbor. After my mother and I returned from chemotherapy that day, we moved a hospital bed into the living room, moved my father to the bed, and that is where he died six weeks later.

There are two separate ways through which I measure time; the first is the thirty-five year mark, an alarmingly red chronological demarcation line that increases medical costs at the fertility clinic and decreases odds of conception. The second is in the passing of time since last winter, in they way I’m never quite sure what month it is, whether I should look for potholes in the road, or replace the air conditioner filters. In sense, I’ve not moved past last January, while my body, consistently uncooperative, has moved on into another, more precarious phase. So it is with some misgivings that I am going to be starting fertility treatments. Some. But less than I would have had, had I not met Nayla.

I’m sorry, how rude. Let me provide an introduction: